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Managing thoracic impalement injuries is well-described in people, but not in veterinary patients. These clinicians present their findings from a review of nine cases of such injuries in dogs to help you prevent life-threatening complications and achieve excellent outcomes.

Thoracic trauma is common in dogs and may result in marked morbidity and mortality because of injury to the lung parenchyma (pulmonary contusion), pleural space (hemopneumothorax), great vessels, thoracic wall (rib fractures), dia phragm, or myocardium.1-5 Thoracic injury may be classified as either blunt, such as vehicular trauma, or penetrating, such as stab wounds. Most cases of penetrating thoracic trauma in animals involve bite wounds in small-breed dogs, although a retrospective study of gunshot wounds at an urban veterinary referral hospital included 32 dogs (39%) with thoracic wounds.5

In people, most penetrating thoracic trauma is from gunshot wounds and stab wounds, although more unusual causes such as golf club injury and swordfish attack have also been described,6-12 as well as a recent well-publicized case involving fatal thoracic impalement from a stingray spine.

Impalement injuries represent an uncommon subset of penetrating trauma, in which the object responsible for the injury is left protruding from the victim or the victim is attached to an object.8 Some impalement injuries, such as those caused by large steel rods in association with motor vehicle accidents, may have components of both blunt force and penetrating trauma.

The tenets of impalement wound management have been well-described in the human medical literature.6-10 It is strongly recommended to leave the object in the individual until the object can be removed under controlled circumstances, either in the emergency room or operating room. Removing impaled thoracic foreign bodies under less-controlled circumstances may be associated with life-threatening hemorrhage or pneumothorax. Additionally, failure to adequately clean and débride the wound increases the risk of pyothorax or incisional infection.13

Conversely, reports concerning impalement injuries in the veterinary literature are limited. Two articles describe the management of penetrating thoracic wounds in horses, while another describes three cats with high-rise syndrome associated with impalement.14-16 In this article, we describe the clinical history, surgical and medical management, and outcomes for a series of dogs with thoracic impalement as well as provide guidelines for the practical management of affected patients.

MATERIALS AND METHODS

We reviewed the surgery logs of the Foster Hospital for Small Animals at Tufts University and Angell Memorial Animal Hospital in Boston from January 1996 to May 2003 to identify all dogs that had undergone thoracotomy for management of thoracic impalement injuries. Cases were included if the object was present within the thorax on presentation or if the object had recently been removed by the dog, owner, or referring veterinarian. Gunshot, stab, and porcupine quill wounds without residual foreign objects were excluded, as were cases with incomplete or missing medical records. The signalment, cause of impalement injury, results of diagnostic imaging, method of object removal, surgical approach, postoperative course, and long-term outcome were recorded for each dog. Collected data were statistically described as either mean ± standard deviation or median and range as appropriate.

RESULTS OF MEDICAL RECORD REVIEWS

Nine cases of thoracic impalement injuries were identified; two cases involved one dog that had two separate impalement episodes. All the dogs were large-breed with a median weight of 70.4 lb (32 kg) and a range of 50.6 to 79.2 lb (23 to 36 kg). Six of the eight dogs were male; five of these were castrated. One female was spayed, and one was intact. Six of the eight dogs were hunting breeds (three Labrador retrievers, a vizsla, a Weimaraner, and a German shorthaired pointer). A Doberman pinscher and a large terrier mix were also affected. The pointer had two separate impalements. The ages at injury ranged from 1 to 6.5 years old with a median age of 3.8 years.

Cause of injury

In seven cases, the impaling object was a stick. One dog fell from a second-story porch onto a branch, while the other six injuries resulted from running into a stick. One Labrador retriever was seen running into a stick, three of the dogs returned from running unobserved in the woods with a stick protruding from their thoraxes, and two were found nonambulatory with a stick protruding from their thoraxes.